Why do Medicare Advantage plans cost zero?

Medicare Advantage (MA) plans offer $0 premiums because private insurers get fixed payments from the government to manage your care, and they use that money, plus cost savings from using provider networks and preventive care, to fund benefits and reduce your monthly premium, sometimes down to zero, while still making a profit. However, $0 premium doesn't mean the plan is truly free; you still pay your Medicare Part B premium, and costs like copays, deductibles, and coinsurance apply when you use services, so you must check the plan's Evidence of Coverage (EOC) for total costs.

What is the biggest disadvantage of Medicare Advantage?

The biggest disadvantage of Medicare Advantage (MA) plans is often the limited provider networks and restricted access to care, requiring prior authorizations, referrals, and potentially forcing you to switch doctors or travel far for specialists, creating barriers to timely treatment, especially for complex health issues, with potential for denials and mid-year changes. While MA offers extras like dental/vision, these networks can significantly limit choice and create hurdles for consistent, high-quality care compared to Original Medicare. 

How do Medicare Advantage plans with no premium make money?

The following are some ways how insurers keep zero-premium plans financially viable: Government Funding: Medicare pays private insurers a fixed, per-person amount each month for managing their care. Whether they visit the doctor or not, the insurer gets this money without any delay.

Who actually pays for Medicare Advantage plans?

Medicare Advantage (MA) plans are paid by the federal government with a fixed monthly amount per person, funded by Medicare's trust funds (from payroll/income taxes, investments), with beneficiaries also paying their standard Medicare Part B premium and potentially plan-specific premiums, copays, and deductibles, with some MA plans even covering part of the Part B premium. Essentially, Medicare funnels federal funds to private MA companies to manage care, and beneficiaries contribute their Part B premium plus any extra costs the plan charges.
 

Why do people say stay away from Medicare Advantage plans?

The main issues are like you mentioned networks and how the insurance companies running Medicare advantage plans run them compared to original Medicare. You are more likely to run into hassle like wrongly denied claims, prior authorizations, and other issues then compared to original Medicare.

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Is it better to have plain Medicare or Medicare Advantage?

Neither Original Medicare nor Medicare Advantage (MA) is universally "better"; the best choice depends on your healthcare needs, budget, and preference for provider choice, with Original Medicare offering nationwide provider freedom but requiring separate drug/supplement plans, while MA provides all-in-one coverage with networks and extra benefits like dental/vision but often requires referrals and has regional limits. 

Why are doctors dropping Medicare Advantage plans?

Doctors and hospitals are leaving Medicare Advantage (MA) plans primarily due to low reimbursement rates, burdensome prior authorization requirements leading to denied care, slow payments, and excessive paperwork, all impacting finances and patient care quality, with many providers finding the administrative load outweighs the benefits. They seek better payment rates or leave networks to avoid financial strain and care delays, even if it disrupts patient access to preferred providers like the Mayo Clinic or NewYork-Presbyterian. 

What is the average cost of a Medicare Advantage program?

Costs of Medicare Advantage

According to the Centers for Medicare & Medicaid Services (CMS), the average monthly plan premium for all Medicare Advantage plans in 2026 is around $14. In addition to the MA plan premium, Medicare members enrolled in an MA plan are responsible for their Part B premium ($202.90 in 2026).

Can you go back to original Medicare from an advantage plan?

Yes, you can go back to Original Medicare from a Medicare Advantage (MA) plan, primarily during the Medicare Advantage Open Enrollment Period (MA OEP) from January 1 to March 31, when you can disenroll and join a Part D drug plan. You can also switch during the Annual Enrollment Period (Oct 15–Dec 7) or under a <<!Special Enrollment Period (SEP)>>, such as if you move out of your plan's service area. When you return to Original Medicare, you'll likely need to enroll in a separate Part D plan and might consider a Medigap policy for extra coverage, but be aware that Medigap might require medical underwriting unless you have guaranteed-issue rights. 

How are Medicare Advantage plans so cheap?

Medicare Advantage (MA) plans are cheap (even $0 premium) because private insurers get paid by the government for enrolling you, then use cost-saving strategies like networks, prior approvals, and efficiency to keep spending below what Medicare pays them; they pass some savings as low premiums or extra benefits, but you still pay Part B and face potential network restrictions or higher copays. 

Why are seniors losing Medicare Advantage plans?

Citing decreased federal payments and rising health care costs, the private health insurers Martin's Point, UnitedHealth and Anthem are pulling their Medicare Advantage plans from New Hampshire in 2026. In Cheshire County, only two insurers will continue offering Medicare Advantage plans.

At what age do you stop paying Medicare premiums after?

Your CalPERS health coverage will automatically be canceled the first day of the month after you turn 65. See Cancellation of CalPERS Health Coverage for information on reinstating your health coverage.

Does everyone have to pay $170 a month for Medicare?

If you don't get premium-free Part A, you pay up to $565 each month. If you don't buy Part A when you're first eligible for Medicare (usually when you turn 65), you might pay a penalty. Most people pay the standard Part B monthly premium amount ($202.90 in 2026).

Why do doctors not accept Medicare Advantage?

The most common reason that doctors may discontinue their acceptance of Medicare Advantage is that the private insurance company makes it difficult or time-consuming for the doctor to get paid for their services.

Which Medicare Advantage plan denies the most claims?

Centene (Wellcare) and CVS Health (Aetna) have faced scrutiny for high prior authorization denial rates in Medicare Advantage (MA) plans, with reports showing they had the most denied requests in 2023, though many denials were overturned on appeal, indicating issues with their strict criteria, while UnitedHealthcare also faces lawsuits and uses technology that has led to increased denials, especially for post-acute care, highlighting systemic challenges with MA plan claim approvals. 

What does Dave Ramsey say about Medicare?

Dave Ramsey's Medicare advice centers on planning ahead, understanding enrollment periods to avoid penalties, using Health Savings Accounts (HSAs) if possible, and supplementing Original Medicare with Medigap or Medicare Advantage (Part C) to cover gaps like dental, vision, and long-term care, stressing that mistakes can be costly and recommending expert advice for personalized choices. 

Why do people say not to get a Medicare Advantage plan?

People warn against Medicare Advantage (MA) plans due to limited doctor/hospital networks, complex pre-authorization for care, higher potential out-of-pocket costs for serious illnesses, annual plan changes (benefits/networks), denials of care, and difficulty switching back to Original Medicare with a Medigap plan later, especially if you become sick. While MA offers extra perks (dental, vision, low premiums), these restrictions can be burdensome, prioritizing insurer profits over patient freedom, making it risky for those with ongoing health issues. 

What is the best health insurance for seniors on Medicare?

There's no single "best" health plan, as it depends on your needs, but top providers for Medicare Advantage (Part C) include Humana, UnitedHealthcare, Aetna, and BCBS, offering diverse benefits like $0 premiums, extra perks, and strong networks, while Medigap (Medicare Supplement) complements Original Medicare by filling gaps, with popular carriers like AARP/UHC, Anthem, and Cigna providing standardized policies (Plans G, F, N), with personalized choices best found via your State SHIP counselor or broker. 

What is the 7 month rule for Medicare?

This is called your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65. My birthday is on the first of the month.

What are the hidden costs of Medicare Advantage?

Medicare Advantage plans bundle these costs into one plan, but you may notice that they charge you additional fees. For example, high drug deductibles and specialist visit copays can add up very quickly over time with some Medicare Advantage plans.

Who has the best Medicare Advantage program?

There's no single "best" Medicare Advantage (MA) plan, as it depends on your needs, but top-rated providers often include UnitedHealthcare, Aetna, Humana, Kaiser Permanente, and Devoted Health, consistently scoring high for network size, customer satisfaction, low costs, or overall quality based on CMS ratings and expert reviews for 2025-2026. Kaiser excels in specific regions like CA, while UHC offers vast networks, Humana for $0 premiums, and Aetna/CVS for integrated care. 

Is it better to go on Medicare or stay on private insurance?

Neither Medicare nor private insurance is universally "better"; the best choice depends on individual needs, but Medicare often offers lower overall costs and simplicity for seniors, while private insurance excels in covering dependents and potentially offering more choice with networks/out-of-pocket caps, though at higher premiums. Medicare boasts lower admin costs and standardized coverage, but Original Medicare lacks an out-of-pocket maximum, a feature typically found in private plans and Medicare Advantage (Part C). 

What is the biggest problem with Medicare Advantage?

The biggest disadvantage of Medicare Advantage (MA) plans is often the limited provider networks and restricted access to care, requiring prior authorizations, referrals, and potentially forcing you to switch doctors or travel far for specialists, creating barriers to timely treatment, especially for complex health issues, with potential for denials and mid-year changes. While MA offers extras like dental/vision, these networks can significantly limit choice and create hurdles for consistent, high-quality care compared to Original Medicare. 

Who are the most overpaid doctors?

The highest-paid doctors in the U.S. are neurosurgeons, thoracic surgeons, and orthopedic surgeons. These surgical specialists earn average annual salaries between $650,000 and $760,000, making them the top earners among physicians.

Which insurance companies deny the most?

In 2023, roughly one third of all in-network claims made to AvMed were denied by the medical insurance company. In this year, AvMed and United HealthCare were the medical insurance companies with the highest denial rate for in-network claims in the United States, at 33 percent each.